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Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone

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Orthopaedic Surgeon
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My son has a cobra splint for a salter XXXXXXX type 2 fracture on the 2nd knuckle on 5th finger right hand. It is over 2 weeks on and I am worried that the splint remains although I think doctor disagreed re this treatment and no hand specialist or physio around this week to see it. Finger remains swollen and discoloured due to lack of circulation as still splinted to 4th finger and I am concerned as this lack of circulation and movement due to cobra type splint. Is this the best procedure for now as worried re wierd position in which bone is healing?
Posted Fri, 7 Sep 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Praveen Tayal 1 hour later
Hello,
Thanks for posting your query.
A fracture of knuckle of finger is usually treated with splinting the finger to the next finger to provide a support to the injured finger. The cobra splint is applied to keep the fracture properly reduced to avoid any malunion.
The swelling in the finger might be due to the injury itself. The bluish discoloration of the fingers is worrisome and can happen due to a tight splint due to the swelling. If you cant get a hand specialist to see, you can loosen the splint slightly so that the reddish coloration of the tips of the fingers return. Keeping the hand elevated will help in reducing the swelling. As far as there is no pain in the area, ischemic changes are unlikely.
You can also get a check X-ray done to see the position of the bone.
The treatment he is getting is the best one as far as the conservative treatment is concerned.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 3 hours later
HI
Son just back from school so just looked at fingers and I believe from your answer that the original plaster cast and 4th/5th finger splint was too tight. I am worried about the colouring - there is red at the tops of the finger tips (getting blood from 1 side) but on the 5th finger on the other side it remains bluish on 2 places and yellowish skin inbetween as if there is no circulation there. It looks like the ischemic or anaemia photos on the web.
Fyi the nurse failed to completly remove the dressing/splint from the 4th and 5th fingers when the plaster cast came off - which I have had confirmed is not usual procedure. We cannot loosen without removing the bandage that ties the 4th/5th fingers together or removing the cotton wad that is between the two fingers either. I will take to doc tomorrow but should I remove bandage in the meantime to get blowflow to that area?
Surely if i keep the hand elevated the bloodflow will be even less?
 
 
Answered by Dr. Praveen Tayal 46 minutes later
Hello.
Thanks for writing again.
The red tops of fingertips are normal. The bluish coloration on the fifth finger is suggestive of a decreased blood circulation to the area. You can remove the bandage that ties the 4th/5th finger in the meantime to improve the blood flow. Raising the hand will decrease the blood flow further but after loosening the bandage, it will help in reducing the swelling. He can use an arm sling to keep his arm in the neutral position.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 18 hours later
HI
Thx for email - took son in to get 4th/5th splint removed which nurse did but she then insisted that it be rebandaged - as did doctor. Clear that the bandaging had been too tight but ciculation now ok.
I note that you call this conservative mangement but would appreicate it if you could explain what the standard accepted progressive method is as I had always been prepared to go to a hand specialist with more moedern splint - which is now gong to occur as well so that there appears to be a lot of nnecessary doubling up in treatment?
When the 4th/5th finger splint was removed it was rotally unhygienic - hand despite ample washing still smells and there was trapped moisture so clear that it was dirty.
My otehr query is as to why my son XXXXXXX cannot now straighten his finger. I believe this is due to the cobra hold bandaging etc being done for too long - and now he will need to see another specialist and do physio on top of everything else? Is this sort of treatment standard as it really doesn't seem to be i.e. is it usual for splint to be on so long that finger cannot straighten? I understand that growth assists finger to heal if any bone malalignment - but surely that should not be an excuse for incorrect treatment.
Finally they refuse to do another x-ray to ensure tighter incorrect bandaging did not misalign finger - is there any chance of that?
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 4 hours later
Hi
I am wondering if I have not heard becaue I have communicated my dissatisfaction with our medical provider and perhaps that puts you in an awkward position. If you are unable to answer this then please let me know as I did not read anywhere that this would be a problem so that the requested advice would not include dealing with such.
My real concern lies with the finger not being able to straighten and their insistence tha the cobra 4th/5th splint continue regardless which is contrary to your advice and common sense.
 
 
Answered by Dr. Praveen Tayal 1 hour later
Hello. Sorry for a late reply.
Dissatisfaction with the treatment given to your son does not affect my advise.
The active management of the fracture involves surgical fixation with screws and nails but since in this fracture, the growing end of the bone is affected, surgical treatment is not usually recommended unless there are multiple pieces of bones which need to be fixed.
The closed reduction and cobra splint is applied to avoid any handling of the growing end so that the bone growth in future is not affected. It is on the doctor's discretion about the way he needs to correct the fracture site.
More than 75% cases of such an injury do heal fully in 6-8 weeks on applying a cobra splint and with adequate immobilisation. The tightened bandage due to the swelling must have caused a considerable discomfort which has been taken care of.
Your son will be able to straighten his finger and function normally after some hot fomentation and physiotherapy.
Please do not worry. Your son is getting the right treatment. You can take a second opinion from a hand specialist.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 14 minutes later
Thanks - my country's remedies for medical concerns is very different hence my query...what I have discovered is that there are more modern treatments which would have been preferable and far simpler all round. Comes down to costs I guess.
Will leave discussion thread open until fter I see hand specialist and revert fyi
Rgds XXXXXXX
 
 
Answered by Dr. Praveen Tayal 1 hour later
I am happy I could help.
Please do inform me the latest developments after consulting a hand surgeon.
Wishing your son an early and trouble free recovery.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 5 days later
HI
Coming back to you now that we have seen the hand specialist who has said that all should be fine due to the ability of the finger to grow and repair itself. I am told that there will be no prolme later in life for my son even though the finger was not properly aligned.
My concern is that the finger had not been aligned before it was put in the plaster cast and usually a more modern hand splint is used. THe current x-ray 3 weeks on is available but I cannot attach it - can you advise how I can as usually only able to do at begining of question I think?
Specialist told me that the fracture is healing even though there were circulation problems/unnecesasry pain from the splint being too tight.
You have mentioned not to worry and that I am getting good care but I consider it adquate care at best. I already know of several grounds where the care was poor re advice and procedure - e.g. splint not removed or cleaned when it should have been, referral to specialists too late and is why i asekd for your clairfication /assitance which was hepful and appreciated.
 
 
Answered by Dr. Praveen Tayal 1 hour later
Hello.
You may attach the X-ray film and report using the "upload your reports" feature on the query page-right hand side.
Otherwise you can send it by e.mail at YYYY@YYYY with subject: ATTN: Dr. Praveen Tayal.
I will give you my opinion after seeing the reports.
Wish him an early trouble free recovery.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 2 hours later
Will send as separate emil as cannot find that rhs part in the question entry page.. XXXXXXX XXXXXXX
 
 
Answered by Dr. Praveen Tayal 8 hours later
Please do let me know after you send me the e. mail so that I can see the reports.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 8 hours later
sent email with x XXXXXXX y'day to customer care email
 
 
Answered by Dr. Praveen Tayal 6 hours later
Hi XXXXXXX

I am sorry; we did not receive your mail. Please do not mind to send it again to YYYY@YYYY with subject as 'Attention to Dr. XXXXXXX Tayal'.

We regret the inconvenience.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Have cobra splint for fracture. Swollen and discolored finger. Worried about healing of bone 1 hour later
Pls see attached as now uploaded on query page here
 
 
Answered by Dr. Praveen Tayal 6 hours later
I have seen the X-ray attached.
The proximal phalanx is broken with minimal displacement. This fracture is likely to heal well with minimal problems later.
Now after 3 weeks, only strapping the finger is enough to heal the fracture site. Please do not worry. This fracture shows a good remodelling and the phalanx will heal well.
Do continue giving him calcium and zinc supplements for a better healing.
Regards.
Above answer was peer-reviewed by
 
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